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Date run 8/23/2007 4:33:40PK SAN JUIN COUNTY ENVIRONMENTAL HE DEPARTMENT Report#5021 <br /> Run by <br /> Facility Information as of 8/23/2 r Pagel <br /> Record Selection Criteria: Facility ID FA0005270 <br /> Make changeslcorrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNER FILE INFORMATION OWNERSHIP CHANGE(date) <br /> Owner ID OW0004126 New Owner ID <br /> Owner Name KEIR, DUNCAN & MABEL <br /> Owner DBA HARBOR SIGNS <br /> Owner Address 1103 GRANTLAND CT <br /> MODESTO, CA 95350 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-467-1616 <br /> Mailing Address 1103 GRANTLAND CT <br /> MODESTO, CA 95350 <br /> Care of DUNCAN & MABEL KEIR <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0005270 <br /> Facility Name HARBOR SIGNS <br /> Location _ <br /> STOCKTON, CA 95206 <br /> Phone 209-467-1616 <br /> Mailing Address 1103 GRANTLAND CT <br /> MODESTO, CA 95350 <br /> Care of DUNCAN & MABEL KEIR <br /> Location Code 99- UNINCORPORATED AREA APN 17710015 <br /> BIDS District 001 -GUTIERREZ, STEVE SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0005728 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name HARBOR SIGNS (Cimle One) <br /> Account Balance as of 8/23/2007: $0.00 <br /> (Circle One) <br /> Transfer to Acfive/Inacwe <br /> Program/Element and Desorption Record ID Employee ID and Name status New Owner? Delete <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PR0501923 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator w agent of same,acknowledge mat all site,and/or project specific,PHSIEHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: '$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: '$372.00= Amount Paid Date / I <br /> Payment Type Check Number Receiv <br /> REHS C71 Date I 7,�/ Account out: Date <br /> COMMENTS: <br /> \\ph s-eh sql-nt\apps\envisions\reports\5021.rpt <br />